目的 分析2017-2019年天津市第四中心医院骨科Ⅰ类切口围手术期预防使用抗菌药物的合理性。方法 收取天津市第四中心医院骨科2017-2019年Ⅰ类切口手术患者1 298例为研究对象，对围手术期抗菌药物的适应症、品种选择、给药时机、用药疗程、联合用药情况进行分析。结果 选取的Ⅰ类切口手术患者，使用抗菌药物的患者有753例（58.01%），其中使用率较高的为髋关节置换术（100.00%）、膝关节置换术（100.00%）、骨折切开复位内固定术（82.90%）、其他（50.53%）、使用率较低的为关节镜清理术（4.76%）、骨折切开复位内固定取出术（4.29%）、皮肤和皮下组织手术（0.94%）。抗菌药物品种选择使用率最高的为头孢唑啉，占比为84.33%；次之为克林霉素，占比为11.69%。术前0.5~1 h开始预防使用抗菌药物的有743例，占98.67%，用药疗程≤ 24 h的患者有638例，占84.73%；无指征延长用药的有55例，占7.30%。联合用药病历有1例，占比0.13%，无联合用药指征。结论 天津市第四中心医院骨科Ⅰ类切口抗菌药物的使用仍存在不合理情况，应多部门加强科学化管理，进一步促进围手术期抗菌药物的合理使用。

Objective To analyze the rationality of prophylactic use of antibiotics in perioperative period of type I incision in Orthopedics Department of Tianjin 4th Centre Hospital from 2017 to 2019. Methods Medical records (1 298 cases) having surgery with type I incision from 2017 to 2019 in Department of Orthopaedics, Tianjin 4th Centre Hospital were selected, and indication, variety, time of administration, course of treatment and combination of antibiotics in perioperative period were analyzed. Results 753 Patients (58.01%) with type I incision were selected and treated with antibiotics, among them, hip arthroplasty (100.00%), knee arthroplasty (100.00%), open reduction and internal fixation of fracture (82.90%), other (50.53%), arthroscopic debridement (4.76%), open reduction and internal fixation of fracture (4.29%), skin and subcutaneous tissue operation (0.94%). The highest use rate of antibiotics was cefazolin, accounting for 84.33%, followed by clindamycin, with the application rate of 11.69%. The antibiotics were used between 0.5-1 h before surgery in 743 cases with the application rate of 98.67%.The course of treatment of antibiotics was less than 24 h in 638 cases (84.73%), there were 55 patients (7.30%) who did not have any indication for prolonged antibiotics. There was 1 case (0.13%) with combined of antibiotics, and was no indication of combined medication. Conclusion The rational use of type I incision antibiotics still exists in Department of Orthopedics Surgery of Tianjin 4th Centre Hospital. Scientific management should be strengthened in many departments to promote the rational use of antibiotics in perioperative period.

R978.1